Humana Expanding Pre-Authorization Requirements

Effective July 1, 2019, Humana is changing its pre-authorization requirements on multiple codes including colonoscopies and tissue grafts/substitutes. These changes will affect most commercial plans, including both HMOs and PPOs.

Common codes that fall under the new changes include 97605 (negative pressure wound therapy), colonoscopy codes 45378, 45380, 45384, and 45385, as well as multiple “C” and “Q” codes. Prior to performing or dispensing any of these services, please make sure to double check benefits and pre-authorization requirements to ensure coverage.

After July 1st, providers can download a copy of the updated pre-authorization guide from the link below.

https://www.humana.com/provider/medical-resources/authorizations-referrals/preauthorization-lists